Introduction: to investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury (BTAI). Methods: MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria: BTAI treated with TEVAR and mean follow-up >60 months. A systematic review was conducted and data were pooled using a random-effects model of proportions applying the Freeman-Tukey transformation. Late reintervention was the primary outcome. Secondary outcomes were procedure-related complications (endoleak, in-stent thrombosis, occlusion, infolding/collapse, bird-beak, migration and left arm claudication), overall and aortic-related mortality and aortic diameter changes. Results: Eleven studies with a low quality assessment were included. Four-hundred-and-eight patients were collected and 389 surviving >30 days were included. The mean follow-up was 8.2 years (95%CI: 5.7-10.8; I2=40.2%). Late reintervention was 2.1% (95%CI: 0.6-3.9; I2=0.0%; 11/389 cases) with 0.1% (95%CI: 0.0-1.2; I2=0.0%; 3/389) occurring after 5 years. Bird-beak was identified in 38.7% (95%CI:16.4-63.6; I2=86.6%). Left arm claudication occurring after 30-day was 3.1% (95%CI: 0.1-8.6; I2=26.9%; 11/140 cases). In-stent thrombosis was 1.9% (95%CI:0.1-5.2; I2=51.8%; 11/389 cases). Endoleak was 0.5% (95%CI: 0.0-1.9; I2=0.0%; 5/389 cases). Infolding, occlusion, and migration were reported in 2/389, 1/389, and 0/389 patients respectively. Overall late survival was 95.6% (95%CI: 88.1-99.8; I2=84.7%; 358/389 patients) and only one patient accounted for aortic-related mortality. The increase in proximal and distal aortic diameters was estimated at 2.7-mm (95%CI: 1.2-4.3; I2=0.0%) and 2.5-mm (95%CI: 1.1-3.9; I2=0.0%) respectively. Conclusions: TEVAR demonstrates remarkably good long-term results and reinterventions are rarely required. Aortic reinterventions tend to occur within the first and after the fifth year.

Systematic Review and Meta-analysis of Long-term Reintervention Following Thoracic Endovascular Repair for Blunt Traumatic Aortic Injury / Gennai, Stefano; Leone, Nicola; Mezzetto, Luca; Veraldi, Gian Franco; Santi, Daniele; Spaggiari, Giorgia; Resch, Timothy; Silingardi, Roberto. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 78:2(2023), pp. 540-547.e4. [10.1016/j.jvs.2023.01.196]

Systematic Review and Meta-analysis of Long-term Reintervention Following Thoracic Endovascular Repair for Blunt Traumatic Aortic Injury

Gennai, Stefano;Santi, Daniele;Spaggiari, Giorgia;Silingardi, Roberto
2023

Abstract

Introduction: to investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury (BTAI). Methods: MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria: BTAI treated with TEVAR and mean follow-up >60 months. A systematic review was conducted and data were pooled using a random-effects model of proportions applying the Freeman-Tukey transformation. Late reintervention was the primary outcome. Secondary outcomes were procedure-related complications (endoleak, in-stent thrombosis, occlusion, infolding/collapse, bird-beak, migration and left arm claudication), overall and aortic-related mortality and aortic diameter changes. Results: Eleven studies with a low quality assessment were included. Four-hundred-and-eight patients were collected and 389 surviving >30 days were included. The mean follow-up was 8.2 years (95%CI: 5.7-10.8; I2=40.2%). Late reintervention was 2.1% (95%CI: 0.6-3.9; I2=0.0%; 11/389 cases) with 0.1% (95%CI: 0.0-1.2; I2=0.0%; 3/389) occurring after 5 years. Bird-beak was identified in 38.7% (95%CI:16.4-63.6; I2=86.6%). Left arm claudication occurring after 30-day was 3.1% (95%CI: 0.1-8.6; I2=26.9%; 11/140 cases). In-stent thrombosis was 1.9% (95%CI:0.1-5.2; I2=51.8%; 11/389 cases). Endoleak was 0.5% (95%CI: 0.0-1.9; I2=0.0%; 5/389 cases). Infolding, occlusion, and migration were reported in 2/389, 1/389, and 0/389 patients respectively. Overall late survival was 95.6% (95%CI: 88.1-99.8; I2=84.7%; 358/389 patients) and only one patient accounted for aortic-related mortality. The increase in proximal and distal aortic diameters was estimated at 2.7-mm (95%CI: 1.2-4.3; I2=0.0%) and 2.5-mm (95%CI: 1.1-3.9; I2=0.0%) respectively. Conclusions: TEVAR demonstrates remarkably good long-term results and reinterventions are rarely required. Aortic reinterventions tend to occur within the first and after the fifth year.
2023
78
2
540
547.e4
Systematic Review and Meta-analysis of Long-term Reintervention Following Thoracic Endovascular Repair for Blunt Traumatic Aortic Injury / Gennai, Stefano; Leone, Nicola; Mezzetto, Luca; Veraldi, Gian Franco; Santi, Daniele; Spaggiari, Giorgia; Resch, Timothy; Silingardi, Roberto. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 78:2(2023), pp. 540-547.e4. [10.1016/j.jvs.2023.01.196]
Gennai, Stefano; Leone, Nicola; Mezzetto, Luca; Veraldi, Gian Franco; Santi, Daniele; Spaggiari, Giorgia; Resch, Timothy; Silingardi, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1296906
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